Abducens Nerve Palsy Treatment & Management
- Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, FRCSC more...
Truly isolated cases often are benign. They can be followed with a serial examination, at least every 6 weeks, over a 6-month period to note decreasing symptoms (diplopia) and resolution of the paretic lateral rectus (increasing motility).[12, 3] Prism measurements are a simple objective method of documenting any changes in the esotropia.
Children with sixth nerve palsy who are in the amblyopic age group can be treated with an alternating patching to decrease their chances of developing any amblyopia in the paretic eye. Additionally, prescribing the full amount of hyperopic correction helps to decrease the esodeviation by relaxing the child's accommodative effort.
Adult patients and those children beyond the amblyopic age can be patched or have their lenses "fogged" with clear tape or nail polish to reduce their diplopia. Fresnel prisms also can be prescribed as an alternative.
Older patients in whom giant cell arteritis is suspected should start the standard treatment with prednisone or intravenous methylprednisolone.
If, after 9-12 months of follow-up care, the remaining deviation is still unacceptable and is too large to be corrected with prisms, surgical corrective options should be discussed with the patient. The procedure that is chosen depends on the remaining function of the lateral rectus and the experience of the surgeon.
If some residual function exists in the lateral rectus, a graded recession of the medial rectus or botulinum toxin to the medial rectus and resection of the lateral rectus can be performed.
When little or no residual function is present, a transposition of the vertical recti toward the lateral rectus (eg, Hummelsheim or the Jensen procedure), can be considered in conjunction with weakening of the ipsilateral medial rectus.
Patients with abducens palsy can benefit from consultation with a neurologist, ophthalmologist, or neuro-ophthalmologist, especially if the lesion does not resolve.
Patients who occlude an eye to alleviate diplopia should be warned that the resulting effects on depth perception may interfere with their ability to drive or perform certain occupations safely.
Evans NM. Ophthalmology. 2nd ed. Oxford University Press Inc; 1995.
Kline LB. Neuro-ophthalmology Review Manual. 6th ed. SLACK Inc; 2008.
Yanoff M, Duker JS. Ophthalmology. Mosby International Ltd; 1999.
Ayberk G, Ozveren MF, Yildirim T, et al. Review of a series with abducens nerve palsy. Turk Neurosurg. 2008 Oct. 18(4):366-73. [Medline].
Denis D, Dauletbekov D, Girard N. Duane retraction syndrome: Type II with severe abducens nerve hypoplasia on magnetic resonance imaging. J AAPOS. 2008 Feb. 12(1):91-3. [Medline].
Calisaneller T, Ozdemir O, Altinors N. Posttraumatic acute bilateral abducens nerve palsy in a child. Childs Nerv Syst. 2006 Jul. 22(7):726-8. [Medline].
Dwarakanath S, Gopal S, Venkataramana NK. Post-traumatic bilateral abducens nerve palsy. Neurol India. 2006 Jun. 54(2):221-2. [Medline].
Kurbanyan K, Lessell S. Intracranial hypotension and abducens palsy following upper spinal manipulation. Br J Ophthalmol. 2008 Jan. 92(1):153-5. [Medline].
Hanu-Cernat LM, Hall T. Late onset of abducens palsy after Le Fort I maxillary osteotomy. Br J Oral Maxillofac Surg. 2008 Dec 16. [Medline].
Anwar S, Nalla S, Fernando DJ. Abducens nerve palsy as a complication of lumbar puncture. Eur J Intern Med. 2008 Dec. 19(8):636-7. [Medline].
Tsai TH, Demer JL. Nonaneurysmal cranial nerve compression as cause of neuropathic strabismus: evidence from high-resolution magnetic resonance imaging. Am J Ophthalmol. 2011 Dec. 152(6):1067-1073.e2. [Medline]. [Full Text].
Rhee DJ, Pyfer MF. The Wills Eye Manual: Office and Emergency Room diagnosis and treatment of eye disease. Lippincott Williams & Wilkins; 1999.